How can I lessen fat pad indentation when smiling? (Photos)

Question

Hi, I’m a 40-year-old female who has always had fairly round cheeks. As I’ve gotten older, an indentation has started to appear on my cheek when I smile, presumably from loss of volume. what would be the best way to make it less pronounced? I have had filler along my upper cheekbone, which provides a slight improvement/lift, but not enough to be significant.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns and photos—it really helps to understand the changes you’re noticing. What you’re describing is quite common as we age. The indentation that appears when you smile is usually due to a combination of natural volume loss in the midface and the way your fat pads move and settle. Even with filler along the upper cheekbone, the dynamic movement of smiling can still reveal these indentations.

To soften this appearance, the most effective approach usually involves strategically placed dermal fillers in areas that support the midface and the cheek fat pads themselves. This can help restore volume and provide gentle lift, so the indentation becomes less noticeable when you smile. Sometimes, a more targeted filler in the mid-cheek or along the nasolabial area—rather than just the upper cheekbone—can create a smoother transition and reduce the “hollowing” effect.

Another approach is fat transfer or microfat grafting, which uses your own fat to restore volume more naturally. This can provide longer-lasting results, though it’s slightly more invasive than filler injections.

Non-surgical skin tightening techniques, like radiofrequency or ultrasound treatments, can complement fillers by improving skin tone and elasticity, but on their own, they generally won’t fill in the indentation.

Ultimately, the goal is subtle restoration that moves naturally with your smile, rather than overfilling a single area. With careful planning, the indentation can be softened significantly, improving your overall cheek contour while keeping expressions natural.

How can I lessen fat pad indentation when smiling? (Photos)

Answers (1)

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